The child's interests and the case for the permissibility of male infant circumcision.

Circumcision of a male child was recently ruled illegal by a court in Germany on the grounds that it violates the child's rights to bodily integrity and self-determination. This paper begins by challenging the applicability of these rights to the circumcision debate. It argues that, rather than a sweeping appeal to rights, a moral analysis of the practice of circumcision will require a careful examination of the interests of the child. I consider three of these interests in some detail. The first is the interest in avoiding a moderate decrease in expected future sexual pleasure. I argue that even if such a decrease were to occur, it is not wholly unreasonable to think that this might actually be a good thing for the child. Second, I consider the interest in self-determination. I argue that this interest is not as strong as it might appear because the adult's circumcision decision is subject to a variety of biases and a significant lack of information. Finally, I consider the child's interest in avoiding the future costs of adult circumcision. I argue that this interest becomes much stronger in the religious case because the child is quite likely to choose to become circumcised as an adult. The likelihood of the child choosing circumcision in the religious case also reduces the extent to which infant circumcision violates his interest in self-determination. I conclude that male infant circumcision falls within the prerogative of parental decision-making in the secular case and even more clearly so in the religious case. Finally, I distinguish male circumcision from female genital cutting in several important respects and argue that we can coherently hold that male circumcision is permissible without also endorsing all forms of female genital cutting.

Outcomes and outputs affiliated with Children's Advocacy Centers in the United States: A scoping review.

BACKGROUND: The Children's Advocacy Center (CAC) model is the predominant multidisciplinary model that responds to child sexual abuse (CSA) in the United States (US). While the CAC model has made important contributions in case coordination and referrals for specialty services, little is known about child- or family-oriented outcomes. OBJECTIVE: Explore the trends and gaps involving outcome and output measures affiliated with CACs in the US. PARTICIPANTS & SETTING: A scoping review of the literature was conducted on English language articles published between 1985-2019 that involved CACs and children less than 18 years of age. METHODS: An electronic database search using the terms "Children's Advocacy Center(s)," "Child Advocacy Center(s)," and "CAC(s)" identified titles and abstracts. Data from articles selected for full text review were evaluated by a multidisciplinary team using a mixed methods approach. RESULTS: Measures of CAC impact frequently focus on service and programmatic outputs with person-centered outcomes left often reported. The most prevalent output measures related to case prosecution and forensic interviews. Person-centered outcomes most commonly emphasized child mental health and caregiver satisfaction. The majority of articles were limited by weak or unspecified study designs. CONCLUSION: The current literature on CACs suggests that while they are successful in coordinating services and facilitating referrals, little is known about how engagement with CACs impacts short- and long-term outcomes for children and families. Further research beyond cross sectional or quasi-experimental designs is necessary to better understand how variability in CAC structure, function, and resources can be optimized to meet the needs of the diverse communities that they serve. This is especially salient given the national dissemination of the CAC model. Without such additional studies, knowledge will remain limited regarding the enduring impacts of CACs on the lives of those impacted by CSA.

Ending child poverty in the good times and the bad.

It is now 10 years since the present Government pledged to eradicate child poverty by the year 2020. Some progress has been made, for example through increases in child benefit and the tax credit system, increased parental employment rates, and children's centres. However, the charity Child Poverty Action Group (CPAG) argues that progress has been disappointingly slow and that some aspects of policy development have undermined this progress. This article discusses the implications of the current economic recession on child poverty and includes the key points from the CPAG's manifesto, published in 2009 to mark the 10th anniversary of the pledge to end child poverty.

Moving research beyond the spanking debate.

Despite numerous studies identifying a broad range of harms associated with the use of spanking and other types of physical punishment, debate continues about its use as a form of discipline. In this commentary, we recommend four strategies to move the field forward and beyond the spanking debate including: 1) use of methodological approaches that allow for stronger causal inference; 2) consideration of human rights issues; 3) a focus on understanding the causes of spanking and reasons for its decline in certain countries; and 4) more emphasis on evidence-based approaches to changing social norms to reject spanking as a form of discipline. Physical punishment needs to be recognized as an important public health problem.

"Who should survive?: one of the choices on our conscience": mental retardation and the history of contemporary bioethics.

The film "Who Should Survive?: One of the Choices on Our Conscience" contains a dramatization of the death of an infant with Down syndrome as the result of the parents' decision not to have a congenital intestinal obstruction surgically corrected. The dramatization was based on two similar cases at The Johns Hopkins Hospital and was financed by the Joseph P. Kennedy, Jr., Foundation. When "Who Should Survive?" was exhibited in 1971, the public reaction was generally critical of the parents' decision and the physicians' inaction. Although technological developments in medicine were a necessary condition for the production of this film and its unanticipated reception, they were not a sufficient condition. The proximate cause was a changed understanding of the capabilities of individuals with Down syndrome. Part of the impetus for this change was data showing the adverse effects of institutionalization on normal children.

Court-mediated disputes between physicians and families over the medical care of children.

OBJECTIVE: To describe the judiciary's approach to parent-physician disputes over the care of sick children. DATA SOURCES: Court publications. STUDY SELECTION: Fifty parent-physician disagreements over the care of children led to physician requests for court intervention and resulted in judicial opinions published by the court. The opinions describe 66 children from 20 states. DATA SYNTHESIS: Physicians prevailed at the initial decision in 44 (88%) of the 50 disputes and at the final decision in 40 disputes (80%). Physicians were more likely to prevail in religion-based disputes than in other cases (27 of 30 vs 13 of 20; P<.03), but they were less likely to prevail in disputes concerning life-threatening or potentially disabling conditions (23 of 31 vs 17 of 19; P<.19). Courts acknowledged the pediatric patients' views in only 10 of the disputes (9 of the 19 cases involving adolescents and 1 of the 31 cases involving children younger than 12 years). For most courts, the petitioning physicians provided the only source of scientific information. CONCLUSIONS: Published court opinions create precedents for future decisions and provide insight into the consequences of seeking court intervention for the physician who encounters parental refusal of care.

Overview of child forensic psychiatry.

The subspecialty of child forensic psychiatry has come into existence relatively recently. The first text on the subject was not published until 1980. This field emerged slowly as a recognized subspecialty separate from general child psychiatry and adult forensic psychiatry because child forensic psychiatry could not exist until children gained legal rights, and courts needed to know the impact of a child's mental state on those rights.

Charting the waves of prevention: two steps forward, one step back.

BACKGROUND: Over the past 30 years, the political response to child maltreatment and its prevention in the US has experienced periods of frantic activity, often followed by long periods of benign neglect. In reflecting on this history, Dick Krugman has referred to this uneven level of attention as a series of "waves" in which apparent progress is often minimized by an inability to sustain political commitment to a given reform or course of action. To an extent, this pattern reflects deep differences among child welfare advocates, researchers, and practitioners on how best to proceed. While most everyone agrees that "it shouldn't hurt to be a child," how to prevent this hurt and at what cost is less clear. METHOD: To address this dilemma, prevention advocates, researchers, and practitioners have struggled with a variety of conceptual frameworks and programmatic reforms. This article summarizes the relative gains and limitation of three such efforts and outlines the lessons these efforts offer those formulating future prevention policies and programs. RESULTS: Specifically, the authors suggest that future prevention efforts will need to take care in avoiding some of the most common mistakes experienced by earlier efforts. CONCLUSIONS: These mistakes or pitfalls include oversimplifying the problem of child abuse; overstating preventions' potential and appropriate target populations; failing to establish a significant partnership with child protective services; compromising depth or quality in an effort to maximize breadth or coverage; and failing to fully engage the public.

Assessment of fairness in child custody decisions.

Court-appointed child advocates, attorneys, guardians ad litem, and therapists were asked to rate preferred traits for mothers and fathers, and to make custody decisions and abuse likelihood ratings for children in one of two vignettes that varied only as to whether mother or father was described as incompetent to parent without threat of further abuse. Results revealed that this sample of professionals did not hold double standards with respect to attributes important for mothers versus fathers. To the contrary, interpersonal sensitivity traits, traditionally identified as most prevalent among women, were valued equally in mothers and fathers and preferred for both parents to interpersonal potency, traditionally ascribed more readily to men. Further, decisions about custody and placement or abuse likelihood were not affected by any sex-role stereotypes professionals held about parents, nor by professionals' gender or specific occupation. The only factor that affected custody judgments and abuse likelihood ratings was the competence of the parent in question. These findings suggest that biases with regard to gender to gender or traditional sex-role preferences for parents are disappearing among professionals who make important placement decisions in the lives of abused children. Future studies must assess whether these theoretical findings translate into actual behavior in real-life abuse cases for the professional groups represented in this sample.

The dental practitioner's role in protecting children from abuse. 1. The child protection system.

The last British Dental Journal article on child protection was in 1986. Since then there have been major changes in both legislation and approaches to child protection. A local authority child protection specialist and a consultant in paediatric dentistry outline the development of child protection and the dental practitioner's role in the inter-agency child protection system in this, the first of three inter-related articles.

Uso de telepsiquiatría para apoyar la atención primaria de salud mental en el tratamiento de niños, niñas y adolescentes con vulneración de derechos: resultados preliminares / Use of telepsychiatry to support primary mental health care in the treatment of children and adolescents with rights violations: preliminary results

he aim of this study was to present preliminary results of a video-based consultation-liaison psychiatry service (telepsychiatry) to enhance the delivery of mental health services in primary health care (PHC) for institutionalized children and adolescents (ICA). A mixed-methods study was carried out at two PHC clinics in Quilpué, Chile, to assess the feasibility of a telepsychiatry service (TPS). TPS consisted of bimonthly, remotely conducted video-conference sessions between PHC teams and child and adolescent consultant psychiatrists located at the Psychiatric University Hospital in Santiago, to discuss mental health problems of ICA. During July to December 2018 thirteen TPS sessions were carried out, and a total of 15 ICA were discussed to elaborate diagnostic and/or therapeutic recommendations. The intervention was useful and acceptable to PHC providers. Participants perceived that better coordination between substitute care facilities and PHC clinics would be useful, and that training opportunities to address the mental health needs of ICA were required. A TPS to enhance the delivery of mental health services in PHC for ICA was feasible, further studies are needed to determine benefits for ICA. (AU)

The mystery of missing female children in the Caucasus: an analysis of sex ratios by birth order.

CONTEXT: Official data on sex ratios at birth suggest a rise in sex-selective abortions in some post-Soviet states following the introduction of ultrasonography. However, questions remain about the validity of official data in these nations as well as whether the high sex ratios at birth are a statistical artifact. METHODS: Trends in sex ratios at birth from 1985 to 2009 for 12 post-Soviet states were examined using vital registration data. For the three countries that had had a Demographic and Health Survey (DHS) in 2005-2010 (Armenia, Azerbaijan and Moldova), survey data were used to calculate sex ratios at birth according to birth order, and vital registration data for 2010 were used to estimate the number of "missing" female births (if any). RESULTS: Official data revealed elevated sex ratios at birth in Armenia (117), Azerbaijan (116) and Georgia (121), but not in other post-Soviet states. According to DHS data, sex ratios were high in Armenia and Azerbaijan for first births (138 and 113, respectively); if the first child was a girl, the sex ratio in Armenia was even higher for the second birth (154). Overall, the number of girls born in these countries in 2010 was 10% lower than expected, consistent with 1,972 sex-selective abortions in Armenia and 8,381 in Azerbaijan. Sex ratios did not vary by birth order in Moldova. CONCLUSION: Sex-selective abortion appears to be common in Azerbaijan and Armenia. Family planning and legal interventions are needed to address this issue.

Current issues and future directions in evidence-based child protection practices: a view from Romania.

The constantly changing nature of social care practice necessitates continuous development of educational programs to prepare current practitioners. Basing social work practice on methodologically sound research evidence is an appealing prospect for the child protection services. However, Romania, once considered an Eastern European model for child welfare policy and practice, is somehow lagging behind. In this article the author gives a short overview of where the Romanian Child Protection System currently stands in terms of evidence-based practice.